FORMS

If you have any questions, please contact our clinic directly at (515)965-1653, (515)262-2655, or (641)753-1374.

If you are a new patient, you will need to complete Patient Information, Health History, and Acknowledgement of Receipt of Privacy Notice forms.

 

If you are an existing patient, feel free to fill out your Health History form prior to your appointment, as we are required to maintain a current Health History form on file every year.

English

Patient Information Form

Health History Form

Acknowledgement of Receipt of Privacy Notice Form

Notice of Privacy Practices

Office Hours:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

7:00am – 5:00pm

7:00am – 5:00pm

7:00am – 5:00pm

7:00am – 5:00pm

7:00am – 5:00pm

CLOSED

CLOSED